Underrepresented minorities are more likely to experience diagnostic and treatment delays, have lower access to quality breast care, have a higher probability of late-stage cancer diagnosis, and experience a number of socioeconomic and healthcare system barriers. The real question is: how can we increase cancer screenings among underserved populations? To tackle this problem, Dr. Vida Henderson, an assistant professor in the Public Health Sciences Division, and her colleagues designed the Mile Square Accessible Mammogram Outreach and Engagement (Mi-MAMO) initiative in 2017 in Chicago. Mi-MAMO is “a community-engaged patient navigation program aimed at linking under-resourced patients and community members to breast cancer screening services, barrier mitigation, and care coordination.”
Community patient navigators help patients obtain appropriate care from complex health systems by connecting them with community resources. “Patient navigation is well-established as being an effective strategy to mitigate individual and interpersonal level barriers to cancer care that are often related to social determinants of health,” Henderson said. “[It] has been associated with increasing cancer screening rates, improving timely follow-up care and preventing delays, facilitating patient-provider communication, linking patients to social needs support services, and providing psychosocial support.” However, it is less well documented how this community-engaged patient program “can also promote substantive change within communities, healthcare systems, and governmental policy, and how we can design these programs to be sustainable,” Henderson added.
In a recent publication, Dr. Henderson and her team, “describe outcomes from a patient navigation safety net program that provides breast cancer screening and navigation services to uninsured and underinsured women; facilitated trust, buy-in, and advocacy from community members, providers and community-based organizations; influenced and supported institutional policies within a healthcare system; and informed governmental policy advocacy and change.”
The Mi-MAMO program began as a pilot program, but its success led to its establishment as an institutional program within the health care system. The authors used the Capacity for Sustainability Framework to incorporate strategies that support long-term sustainability of the Mi-MAMO program. The framework is composed of nine factors, each of which is an objective of the program: Funding Stability, Political Support, Partnerships, Organizational Capacity, Program Adaptation, Evaluation, Communications, Public Health Impacts, and Strategic Planning. Each goal was evaluated by the authors to determine which program activities helped, and which needed to be incorporated, to achieve their objectives.
In this study, “we describe how we used the Capacity for Sustainability Framework to guide efforts for program sustainability and community, institutional, and policy level change and provide recommendations for creating sustainable safety net cancer screening programs,” Henderson said. The authors received positive feedback from interviews they conducted with 18 women participating in the Mi-MAMO program. “Women felt that receiving mammograms close to their homes, receiving program transportation assistance with Lyft rides for those with transportation barriers, and obtaining mammograms and follow-up care at no cost (among uninsured women) were valuable to them.” Moreover, the authors found that “women reported that the ability to walk into a friendly, warm, and welcoming clinic anytime on a Walk-In-Wednesday to obtain a mammogram was convenient and added to their willingness to obtain a screening. “Overall, this study demonstrates the “effectiveness of patient navigation programs in promoting cancer health equity and addressing cancer disparities among low-income and minoritized groups at multiple ecological levels.”
“Patient navigation programs are often funded through small service grant mechanisms from local health departments and foundations – and unfortunately, once the funds run out, and if there is no institutional support, the programs end despite any gains.” Henderson continued, “through policy advocacy, multi-stakeholder buy-in and engagement, community support, and dissemination of program evaluation outcomes to all stakeholders, we were able to create a breast cancer screening navigation program that now has sustainable funding and is in its seventh year.” Moreover, “concerted efforts of legislators, researchers, providers, community advocates, and community clinics resulted in Illinois passing a bill for payor reimbursement for patient navigators/community health worker services.” In fact, “since this time, legislation has been passed nationally to support reimbursement for patient navigators. This is a big win that I believe is a direct result of nationwide advocacy efforts and a paradigm shift in how we approach healthcare. Policy that is informed by our research is how we move the needle and dismantle oppressive systems that perpetuate cancer inequities,” Henderson stated.
Henderson’s work aims to “inform future work on creating sustainable patient navigator programs for not only cancer screening but also for clinical trials, cancer genetic risk, and social needs navigation.”
Henderson and her team hope that this study contributes to "more support for system-level support of patient navigator programs, given their effectiveness in mitigating barriers to cancer prevention and care.”
Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium member Dr. Vida Henderson contributed to this work.
This work was funded by the Chicago Department of Public Health, the University of Illinois Cancer Center, and the University of Illinois in Chicago Hospital and Health Sciences System.
Zumba EM, Watson KS, Torres P, Williams B, Mannan N, Green L, Owens B, Gastala N, Bueno R, Soto B, Carnahan L, Molina Y, Henderson V. Expanding Outcomes in Cancer Screening Safety Net Programs: Promoting Sustainability and Policy Reform. Health Educ Behav. 2024 Feb 12:10901981241231502.