Building Mixtec Community Capacity for Breast Health,Phase 3

Institution: University of California, Los Angeles
Investigator(s): Annette Maxwell, DrPH - Sandra Young,  -
Award Cycle: 2016 (Cycle 22) Grant #: 22BB-1900 Award: $534,659
Award Type: CRC Full Research Award
Research Priorities
Community Impact of Breast Cancer>Disparities: eliminating the unequal burden of breast cancer

This is a collaboration with: 22BB-1901 -

Initial Award Abstract (2016)

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. MICOP provides referrals to health and social services, case management, trainings and educational workshops,  language interpretation services, and has its own radio station with programs in Mixteco and Spanish. UCLA and MICOP have completed two CRC pilot studies (focus groups, in-depth interviews and almost 1,000 household surveys) which showed that this community is lacking access to health care, especially preventive care and has extremely low breast cancer screening rates (11% of women 50 years and older had a mammogram within the past 24 months). Based on community and reviewer suggestions, we developed this study to broadly address breast health, by promoting a wellness visit as an entry point to the medical care system. This visit is focused on preventive care and provides the opportunity for age-appropriate breast cancer screening, and breast health education and counseling to address risk factors.

Question(s) or hypotheses:
This application for a Full CRC Award is to our knowledge the first intervention trial in the Mixtec community with a focus on breast health. It combines two approaches that the community wants and is very excited about:

(1) an individually-directed intervention, in which trained promotoras conduct outreach and education on wellness visits and breast health and navigate women to local clinics and programs, including the state-funded Every Woman Counts program.

(2) a radionovela, that will provide basic information potentially to the entire community in an effort to raise awareness on the importance of wellness visits and breast health.
The study will answer the following research questions: How effective is a promotora intervention in increasing the proportion of women who will obtain a free or low-cost wellness visit? Other important outcomes are receipt of age-appropriate breast cancer screening, women’s awareness of and behaviors regarding lifestyle factors that promote breast health and aspects of patient-provider communication,

General methodology:
MICOP will train a group of promotoras on how to navigate women to local clinics that provide free wellness visits and mammograms, in collaboration with the state-funded Every Woman Counts program. In collaboration with the UCLA Art & Global Health Center and PCI Media International, we will take community groups through a series of workshops to help them develop stories and characters for a radionovela with a subplot related to breast health and screening. Community members will participate in the professional production of 8 episodes of 5-10 minutes each. Posters and fliers with indigenous art will advertise the radio station and the radionovela. In years 2-3, we will enroll 150 women 40 years and older in a randomized trial to test the effectiveness of the promotora intervention to increase the proportion of indigenous women who obtain a wellness visit, compared to women in the control group.

Innovative elements:
Innovative aspects of this proposal are the focus on an indigenous community; testing of a promotora intervention in a randomized trial; development of a culturally appropriate radionovela with stories and characters generated by community members, and assessing the exposure to radio programs in the community to assess the utility of this innovative communication channel for future studies.

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. While we will conduct a randomized trial with 150 women, a large number of community members will participate in the development and production of the radionovela.

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. We will seek community input to direct our future research. Long-term goals are to continue to build the Mixtec community capacity to engage in research and to promote breast health.


Providing Health Education to Mixtec Farmworkers in California via Workshops and Radio: A Feasibility Study
Periodical:Health Promotion Practice
Index Medicus:
Authors: Young S, Gomez N, Maxwell AE
Yr: 2018 Vol: Epub Nbr: Abs: Pg: