Nuevo Amanecer: Promoting the Psychosocial Health of Latinas

Institution: University of California, San Francisco
Investigator(s): Anna Napoles, PhD, MPH - Carmen Ortiz, Ph.D. -
Award Cycle: 2009 (Cycle 15) Grant #: 15BB-1300 Award: $349,547
Award Type: CRC Full Research Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

This is a collaboration with: 15BB-1301 -

Initial Award Abstract (2009)

Among some women, a breast cancer diagnosis can cause emotional (psychosocial) problems, such as anxiety and distress. Support services are recommended as part of routine cancer care because they can improve the quality of life of some of these women. Spanish-speaking Latina women with breast cancer may be more likely to experience distress than White women because of a lack of information and resources in Spanish, and economic and cultural factors. Several community-based organizations (CBOs) and Latina breast cancer survivors have joined together to increase access to support services for Latinas with breast cancer.

This project will test whether a Spanish-language, culturally appropriate Peer Support Counselor (PSC) program, called Nuevo Amanecer (A New Dawn), can reduce anxiety and distress, and improve quality of life among Spanish-speaking Latina women after being diagnosed.

We will take a program that is effective in improving quality of life in women with cancer and adapt it and translate it so that it is appropriate for Spanish-speaking Latinas. The program will teach women how to better handle the stress of the diagnosis and subsequent changes by using their own strengths to adjust. The 12-week program will be adapted with the input of Spanish-speaking Latina breast cancer survivors, a highly experienced community partner, and a Community Advisory Board (CAB) made up of 14 community organizations, physicians, and service providers, and 18 Latina cancer survivors. The program will be delivered by peers (Spanish-speaking Latinas who have had breast cancer) and will consist of in-person support sessions and follow-up telephone support to be provided in convenient community settings. We will test the program’s effectiveness by randomly assigning 170 newly diagnosed Spanish-speaking Latinas with breast cancer to one of two groups: half will receive the program, and the other half will receive their usual health care services. To assess the effectiveness of the program, we will interview women before and after the program and ask them about their anxiety, distress, and quality of life, and compare the two groups. Women who received usual services will be offered the Nuevo Amancer program after the interviews are completed.

This project is unique because it will test a new support program developed specifically for Spanish-speaking Latinas with breast cancer that is based on previous research conducted by the study team. This project will increase the capacity of several communities to provide culturally relevant support to Spanish-speaking Latinas with breast cancer. It will highlight the strength and wisdom of Latinas who have grown from the cancer experience, and wish to give back to their communities by making that experience a little easier for similar women who will forever be changed by the words “you have breast cancer.”

The pilot study emerged from numerous requests to the community partner, Círculo de Vida Cancer Support and Resource Center (CDV) from CBOs and Latina cancer survivors for training on providing psychosocial support to newly diagnosed Latinas. The Executive Director of CDV, Dr. Carmen Ortíz, is a Latina breast cancer survivor and clinical psychologist with extensive experience assisting CBOs in developing cancer support programs. She and her staff identified the research aim. In the CRC pilot study, a broad-based coalition consisting of CDV, the Academic Partner (a Latina cancer researcher at UCSF), Latina cancer survivors, Latino health advocates, and health care providers, identified the program components that are most effective in reaching Latinas and improving their adjustment to breast cancer. This coalition will work together to shape and test the Nuevo Amanecer program, make sure we ask the right questions, and interpret and disseminate the results.

We will work with the CAB and other community groups to obtain additional funding (e.g., National Cancer Institute, Lance Armstrong Foundation) to continue to test and disseminate this and similar programs that aim to reduce psychosocial health disparities associated with cancer. We are working with CBOs who have the infrastructure to support expansion of their services to include a PSC component for sustainability. We will offer the program manuals and technical assistance to agencies in other geographic areas where there is a great unmet need for cancer support services. A technical assistance manual for CBOs on peer support for Latinas with breast cancer developed in the pilot study will serve as a model for future dissemination activities.

Final Report (2013)

Spanish-speaking women with breast cancer are at high-risk of psychological distress and poor quality of life. Cognitive-behavioral stress management (CBSM) programs have been shown to improve quality of life in White women, but we need evidence that they work for Latinas and are culturally appropriate. This study aims to develop a culturally appropriate, peer-delivered CBSM program for Spanish-speaking Latinas with breast cancer and test its effectiveness in a community-based randomized controlled trial (RCT), enrolling 170 women in the study (85 in the treatment group and 85 in the wait-listed control group). Our major accomplishments include development of a manualized 8-week, culturally-appropriate, Spanish language CBSM intervention called Nuevo Amanecer (A New Dawn); maintenance of a stable academic and community study team; holding our annual community advisory board (CAB) meeting; finalization of a data management system; enrollment of 60 Latina women to date; entry and cleaning of data collected thus far; analysis of baseline data for current enrollees; 100% retention of enrollees thus far; completion of 41 3-month and 34 6-month assessments; and writing of statistical programs to analyze RCT results. Barriers consist of the time-intensive nature of meeting with numerous clinical sites and personnel to request referral of women to the study and timely identification of eligible women. We are requesting a 1-year no-cost extension and anticipate successfully recruiting sufficient participants to assess the results of the RCT using our multi-pronged recruitment strategies. Plans for next year are to: complete enrollment of study participants; complete follow-up assessments; hold another CAB meeting; analyze the process and outcomes data, and develop several manuscripts on the program and study design, process measures, and RCT outcomes data.

Randomized controlled trial of Nuevo Amanecer: a peer-delivered stress management intervention for Spanish-speaking Latinas with breast cancer.
Periodical:Clinical Trials
Index Medicus:
Authors: Nápoles AM, Santoyo-Olsson J, Ortiz C, Gregorich S, Lee HE, Duron Y, Graves K, Luce JA, M
Yr: 2014 Vol: 11 Nbr: 2 Abs: Pg:230-8