Building Mixtec Community Capacity for Breast Health,Phase 2

Institution: University of California, Los Angeles
Investigator(s): Annette Maxwell, DrPH - Sandra Young,  -
Award Cycle: 2015 (Cycle 21) Grant #: 21AB-2000 Award: $193,440
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

Initial Award Abstract (2015)

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. 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 for the indigenous community in Oxnard, Ventura County. UCLA and MICOP have completed a CRC pilot study (focus groups and almost 1,000 household surveys) which showed extremely low breast cancer screening rates (11% of women 50 years and older had a mammogram within the past 24 months) and provided suggestions from the community on how to promote breast health. We also introduced many community members to research and developed acceptable research methods.

Question(s) or hypotheses: This application for a second Pilot CRC Award proposes to conduct qualitative research on key issues that will shape future interventions to promote breast health in the indigenous community. We will seek to understand community norms regarding what constitutes good health, how to maintain health and how to prevent disease. We will learn about community experiences with the health care system, specifically when community members seek health care, how they communicate with health care providers and to what extent do they understand what providers tell them, and what financial implications of utilizing the health care system are. We will also explore factors that positively and negatively affect breast cancer risk, such as lifestyle and environmental factors. We will debrief promotoras and interpreters who are employed by health care providers in Oxnard to learn from their experiences of how they assist community members to navigate the health care system, what strategies they use successfully and what obstacles they encounter in their daily work with this population.

General methodology: We will train indigenous promotoras to conduct one-on-one in-depth interviews in indigenous languages or Spanish and to prepare a detailed written or oral report of what was discussed and what opinions were expressed by respondents. Trained promotoras will conduct one-on-one interviews with indigenous women. They will debrief indigenous women after a health care encounter to learn details of a specific health care experience; and they will pose a series of questions to promotoras and interpreters and ask them to recount recent experiences with patients (without revealing their names). While some of these queries will be structured by an outline of questions and topics, others will be relatively open and unstructured following the tradition of story-telling, Promotoras will audio-record the interviews and work in a team to transcribe the discussions into Spanish or English. Data will be analyzed using techniques based on grounded theory methodology.

Innovative elements: Innovative aspects of this proposal are the focus on an indigenous community, focus on community norms and behaviors regarding health and disease prevention that will guide us in framing future programs on breast health, drawing on the experiences of indigenous navigators and interpreters who assist this community in a number of health care settings, and exploring a new methodology of having trained promotoras transcribe key informant interviews in a team approach.

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, Every Woman Counts and UCLA. The Mixtec Advisory Committee as well as a group of 10 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 and Zapotec 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.

Future Plans: Our research partnership is committed to continue research in the indigenous community relevant to breast health, such as nutrition and safety around pesticides, as well as other health issues. An in-depth understanding of the issues that will be explored in this qualitative study will provide a strong foundation for a future intervention to address breast health in this community. Long-term goals are to continue to build the Mixtec community capacity to engage in research, to address breast cancer disparities and to promote breast health.

Progress Report 1 (2016)

The long-term goal of the MICOP/UCLA partnership is to build the Mixtec community capacity to implement evidence-based strategies in their community that will positively impact preventive health behaviors, including health behaviors relevant to breast health. In phase 2 of this partnership, we are conducting qualitative research on key issues that will shape future interventions to promote health care utilization in the indigenous community.

AIM1: Train 2-4 indigenous promotoras to conduct one-on-one structured in-depth interviews, that include a detailed written or oral report in English or Spanish of what was discussed and what opinions were expressed by respondents (including quotes).

Progress to date: The research team developed a 2-day Spanish-language training for promotoras that included: Introduction and purpose of the study; IRB training; and explanation and role play of the study protocol (recruitment strategies, administering informed consent, the interview process, taping of the interviews). Training was conducted on October 17 and October 24, 2015 at MICOP. The interview outline was developed by UCLA and MICOP with community input.

AIM 2: Trained promotores will conduct one-on-one structured interviews with
25 indigenous women age 18 to 75;

10-15 indigenous women who just completed a health care visit (exit interviews); and

5-10 navigators and interpreters who have worked with indigenous patients in health care settings in Oxnard to learn from their experiences on how they assist community members to navigate the health care system. This will provide a better understanding of issues that positively and negatively affect breast cancer risk, prevention and early detection; access to health care; and navigation of the health care system, including health literacy and patient-provider communication.

Progress to date: Sandy Young conducted 5 interviews with navigators and interpreters at Oxnard clinics in Spanish. Two trained Spanish-Mixteco and Spanish-Zapoteco bi-lingual promotoras are in the process of conducting one-on-one in-depth interview, each lasting about one hour, with indigenous women. They audio-record the interviews. Interviews conducted in indigenous languages are subsequently translated and audio-recorded in Spanish, followed by a translation and transcription into English. To date, most women report difficulties with accessing health care, not being aware of discount programs and communication problems.

Next steps: Our research group will continue to develop a better understanding of the health care experience of women in this community. This will provide a strong foundation for a future intervention study to promote breast health.

Understanding Factors that Influence Health Care Utilization Among Mixtec and Zapotec Women in a Farmworker Community in California
Periodical:Journal of Community Health
Index Medicus:
Authors: Maxwell AE, Young S, Moe E, Bastani R, Wentzell E
Yr: 2018 Vol: 43 Nbr: 2 Abs: Pg:356-365