Navigating rural women for breast and cervical screening

The UAB Comprehensive Cancer Center Outreach Office has a partnership with the Alabama Breast and Cervical Cancer Early Detection Program (ABCCEDP) that utilizes our community Health Advisor (CHA) model and local staff to identify, reach and navigate women who are rarely or never screened for breast and cervical cancer. The ABCCEDP is aimed at increasing screening for breast and cervical cancer in women, ages 40-64. The ABCCEDP is part of a national program that provides breast and cervical screening to women in the 6 rural Black Belt counties and 1 urban county. Today, the Black Belt is home to some of the most underserved counties in the United States. Along with high rates of poverty, the Black Belt is home to mostly agricultural landscapes with poor access to education and medical care, low-quality housing and high unemployment rates. African Americans make-up over 52% of the population living in the Black Belt region and experience many of the barriers that are characteristic to the area.

Kathy Levy is a Choctaw/Marengo County “community navigator” who is from Butler, AL. Kathy has worked for a number of years coordinating community outreach programs and has been very successful in recruiting women for breast and cervical cancer screening. A particular instance that represents Kathy’s continued success is how she was able to get two sisters screened for breast and cervical cancer together. Kathy received a call from one of the sisters who wanted to know how she could get a mammogram and pap test. Kathy told her about the ABCCEDP’s free screening program and asked if she had transportation to get herself to her appointment. The sister told Kathy that she did not have a car to drive but that her sister did. Kathy’s next question was, “Well does your sister need a mammogram and pap test as well?” The sister said that she doesn’t have insurance and would also benefit from the free screenings. Kathy told her to have her sister call her so that Kathy could get her information and make her an appointment as well. Kathy made the sister’s appointments back-to-back so that they could ride together and also hold each other accountable for following through with their appointments.

“It is important to show love and care to people in the community,” said Kathy. “You must show them love to get into their world and be their friend. That is how I reach people and help them get their cancer screenings.”

Kathy has had a lot of success contacting and navigating patients to be screened for breast and cervical cancer. From June 2016 until March 2017, Kathy has reached 5,824 women through 58 outreach events. These outstanding numbers come from the love that Kathy shows people in the community and her deep understanding of the barriers many of them face. Kathy’s success is based on her ability to reach people where they are. From telling women who may be on the streets to deciphering hidden relationships and communication.

Here’s how you can follow Kathy’s example:

  1. Build trust; meet people where they are

  2. Rely on word-of-mouth

  3. Make church announcements and post flyers at church

  4. Use the events calendar in the newspaper and attend the events to pass out flyers

  5. Pay attention and talk to people at the grocery store

  6. Advertise the word "free"

  7. Post flyers and information at apartment complexes so they can use them for their "healthy meeting topics"

Kathy built relationships to get both of the sisters screened. Understanding relationships and the part that they play in our lives is so important in reaching people. Understanding the barriers that people may face that keep them from making or attending doctor’s appointments is a vital part in community outreach and increasing screening.

Quick Tips

•Value of community health workers who are respected in their communities

•Every interaction is an opportunity to increased screening

•Must have passionate partners to work toward your initiative

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