Interactive Technology to Support Rural Women and Families

Institution: Stanford University
Investigator(s): Cheryl Koopman, Ph.D. - Mary Anne Kreshka, M.A. - Speranza Avram, MPA -
Award Cycle: 2003 (Cycle IX) Grant #: 9AB-1400 Award: $3,333
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

This is a collaboration with: 9AB-1401 -

Initial Award Abstract (2003)

Background: Women living with breast cancer who reside in rural areas may gain greater access to support group intervention that uses videoconferencing to connect members with one another and with a trained group facilitator. We will pilot such an intervention in Plumas, Modoc, and Siskiyou Counties, using the supportive-expressive model to guide the support groups because it has been shown to be an effective style of intervention for women with breast cancer for reducing social isolation, promoting expression on an emotional level, and reducing distress. In this pilot study, this support group model will be augmented with the workbook-journal “One In Eight, which we have found in previous CRC research to be beneficial for women with breast cancer at risk for social isolation.

1. To determine the feasibility and acceptability of using videoconferencing to reduce rural/urban inequities in access to psychosocial support for women with breast cancer residing in three rural counties in northeastern California (Modoc, Plumas, and Siskiyou).
2. To evaluate whether the psychosocial support needs of women with breast cancer in these counties, as the women understand the needs themselves, can be met through participation in support groups via videoconferencing.
3. To promote the ongoing capacity of the communities in the target region to use videoconferencing to improve access to psychosocial support for women with breast cancer.

Methods: Forty women living with breast cancer will be offered a support group intervention using videoconferencing at three NSRHN videoconferencing sites: Plumas District Hospital in Quincy, Modoc Medical Center in Alturas, and Siskiyou Family Practice in Yreka. For each woman, we will obtain her informed consent, assess her prior to the intervention on validated psychosocial measures, provide her with the 8-week support group intervention augmented by the workbook journal, “One In Eight,” and after the intervention elicit her perspective using both questionnaires and also an interview to obtain her feedback about the feasibility and utility of the intervention. The support group facilitator and the facility coordinators will also be interviewed after the support groups have taken place. These data will be analyzed to address the aims and hypotheses. We will produce a training manual for facilitating breast cancer support groups via videoconferencing. That will be made available to other communities.

Impact on breast cancer: This research has the potential to inform the design and implementation of a support group intervention that would be readily accessible to women living with breast cancer who reside in rural areas. This project would expand the potential of technological modalities that are already in use in rural California counties for providing psychosocial support. This pilot study would provide us with knowledge about the feasibility of expanding this project to sixteen counties of northern California that are served by the Northern California Breast Cancer and Cervical Cancer Partnership. If this project is successful, it will provide a tangible model for widespread use of videoconferencing to expand access to support groups for women living in rural areas, which could lead to establishing this intervention as part of routine care for this population.

Final Report (2005)

This award was a research assistance grant to the Northern Sierra Rural Health Network and to Stanford University to further develop the Community Research Collaboration (CRC) application submitted for CBCRP's funding cycle IX: "Using Telemedicine to Improve Rural Women's Quality of Life".

The purpose of the award was to enable the applicants, especially the community agency (Northern Sierra Rural Health Network) to address scientific and collaborative issues raised during the scientific peer review of their CRC application.

The most important aspects of the work that was conducted during the course of this award was as follows:
1. Strengthen scientific elements of the application. This has been done, specifically:
• Conceptual framework: we changed the conceptual basis of the study. The primary focus is no longer therapeutic outcomes, but rather equality of access to services. Additionally, the conceptual relationships between the Supportive-Expressive support group model and the measures that will be used have been described in the application.
• Recruitment: Women with any stage of breast cancer at any point of their illness will be eligible for participation, as was requested during our meetings with women with breast cancer in Quincy and Alturas.

2. Strengthen the collaborative elements of the application. This has been done, specifically: The Community Advisory Boards will include people (mainly women with breast cancer) who met with members of the study Implementation Team in Quincy and Alturas as this study was being planned, and who attended the demonstration of a videoconferencing support group. The suggestions these people gave us about how to design the study have been incorporated into our proposal.

3. Submit a revised Concept Paper by the deadline of Thursday, November 6, 2003. We submitted the revised Concept paper by this deadline.

4. Submit a revised CRC application by the deadline of Thursday, Feb. 26, 2004. We submitted the revised CRC application by this deadline, which was titled: "Expanded Rural Access: Distance Delivery of Support Groups: A Proposed Pilot Study," which we are pleased to know is now being funded.

This research has the potential to inform the design and implementation of technology-based intervention that would be readily accessible to rural women with breast cancer. This would tap the potential of technology that is already in use in the nine rural counties served by NSRHN for providing psychosocial support. Our future plans are to implement this pilot project and to disseminate the findings and train health care providers with the hope of establishing one or more types of psychosocial support delivered via videoconferencing as part of routine care for rural women with breast cancer on a continuous basis.